BOISE — Medicaid expansion passed its first major legislative hurdle Monday, when the Senate approved the fiscal 2020 Medicaid budget on a 31-3 vote.

The measure now moves on to the House, where the vote is expected to be much closer.

The budget authorizes $2.83 billion in total funding for the Department of Health and Welfare’s Medicaid Division next year. That includes $1.89 billion in federal funding — an increase of $327.9 million or 21 percent — as well as $255.3 million in dedicated funds and $686.9 million in general fund support.

Most of the money will go to support the traditional Medicaid program.

However, the budget also includes $197.3 million for the first six months of expanded Medicaid eligibility, which is expected to be implemented Jan. 1. The federal government will cover almost that entire amount; Idaho taxpayers will contribute $9.3 million in general fund support, but that will be offset entirely by savings in other agency budgets.

There was a fair amount of debate on the measure, although only three senators voted against it: Sens. Don Cheatham, R-Post Falls; Lori Den Hartog, R-Nampa; and Steve Vick, R-Dalton Gardens.

Vick noted that the total Medicaid appropriation — including federal and dedicated funds — has grown almost 400 percent since 2001, while the Idaho population has increased just 33 percent.

“I think at some point in the future (expanding Medicaid) will haunt us,” he said. “In the long term, there are only two ways to pay for it: cutting school funding or raising taxes.”

Other lawmakers, however, indicated that rising health care costs are driving much of the Medicaid budget. For the working poor who can’t otherwise afford medical care, those costs will either be paid for by the federal program or through county indigent funds and/or cost shifts to people with private health insurance.

“If you say you aren’t going to do this, that it’s everyone for themselves, you and I are going to end up paying for it anyway,” said Sen. Grant Burgoyne, D-Boise. “It’s going to get paid through cost shifts. Our insurance premiums will go up, our constituents’ premiums will go up, and that’s a tax.”

Sen. Jim Guthrie, R-Inkom, agreed, saying Medicaid isn’t immune from the rising health care costs that are hurting the private sector.

“If I thought not voting for this (budget) would address that problem, I’d be the first to vote no,” he said. “But it won’t. I don’t think we have the luxury to vote no just because we don’t like the numbers.”

Although more than 60 percent of Idaho voters supported Medicaid expansion last fall, it remains unclear whether there are enough votes in the House to pass the funding bill.

The governor has indicated that he won’t let the Legislature adjourn for the year without appropriating the money to pay for expansion. Some House Republicans, however, are equally adamant that they won’t support the budget unless various sideboards or restrictions are put in place to help control the growth of the program.

Legislation to that effect was introduced last week and could be voted on this week by the House Health and Welfare Committee.

Spence may be contacted at or (208) 791-9168.

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